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The Obamacare rollout has been a debacle, with delays in the implementation of mandates, technical glitches in the exchanges, cancelled individual policies and more.

It's about to get worse. The federal judiciary is currently hearing four cases challenging decisions made by the Internal Revenue Service that could soon deliver more major blows to the Affordable Care Act.

One such decision extended subsidies provided by Obamacare for lower-income individuals and families (those making up to four times the povery level) to people in the 36 states served by the federally-operated exchange, HealthCare.gov.

But the law spells out clearly that such federal subsidies will be granted "through an exchange established by the state" - not that they can be granted by the federal government.

Fair enough. But why would anyone sue to prevent the federal government from giving them money?

Surprisingly, some folks will actually face higher healthcare expenses if they take the federal government's cash.

The first lawsuit - Halbig vs. Sebelius - shows how. One of the plaintiffs, David Klemencic, a West Virginia man who does flooring work, argues that under the Affordable Care Act, he is exempt from the individual mandate because of his low income.

But if the federally operated exchange is authorized to hand out subsidies in his state, he'll no longer be eligible for the exemption. He'll either have to buy an insurance plan on the exchange or pay the fine for refusing to comply with the mandate.

In both instances, his wallet would be lighter than if he were allowed to simply go without insurance.

Klemencic isn't alone. Two other lawsuits that turn on the same issue - that is, whether the federal government is legally authorized to distribute subsidies in the 36 state exchanges they operate - are wending their way through courts in Richmond, Va., and Oklahoma.

There's a fourth legal challenge facing the IRS in Indiana, where the state and 15 public school districts are disputing a ruling from the agency that would extend the employer mandate to state and local governments.

Indiana Attorney General Greg Zoeller argues that the penalties for failing to comply with the employer mandate - which have been justified by the U.S. Supreme Court as "taxes" - should not apply to his state because the federal government doesn't have the authority to levy taxes on state governments.

The Indiana school districts claim that they'll have to reduce working hours or lay off workers in order to shoulder the increased costs - or financial penalties - the employer mandate would impose upon them.

These school staffers won't be the only ones harmed by the IRS's interpretation of the law. Students will suffer, too, as their teachers will be forced to put in fewer hours.

The decisions in these four cases will only be binding in the jurisdictions where they're brought. But as the American Enterprise Institute's Thomas P. Miller notes, court rulings against the IRS rules and the federal subsidies could create a ripple effect, encouraging other states without state-based exchanges to file similar cases..,,

How many times have you heard that the Affordable Care Act has been successful at holding down health-care-cost growth? A lot, I bet. It’s a claim, as Yuval Levin points out below, that has been made regularly by administration officials and pundits alike. Here is White House advisor David Cutler in a recent Washington Post’s piece called “The health care law’s success story: slowing down medical costs.” He writes:

Before he was criticized for his statements about insurance continuity, President Obama was lambasted for his forecasts of cost savings. In 2007, Obama asserted that his health-care reform plan would save $2,500 per family relative to the trends at the time. The criticism was harsh; I know because I helped the then-senator make this forecast. Yet events have shown him to be right. Between early 2009 and now, the Office of the Actuaries at the Centers for Medicare & Medicaid Services has lowered its forecast of medical spending in 2016 by 1 percentage point of GDP. In dollar terms, this is $2,500 for a family of four.

Chuck Blahous responds to this paragraph in his column at Economics 21 this morning. Blahous, as Yuval explains, consults the evidence and calls the piece a ”particularly egregious example” of distorting the data:

To see why this is wrong, it is useful to break down this paragraph’s thesis into its component parts. Specifically, it claims that:

The President’s previous assertions that his “health-care reform plan” would “save $2,500 per family” have been “shown” “to be right,” and that;
This is proved by the fact that the CMS actuaries have lowered, between early 2009 and now, their forecast of medical spending in 2016 by $2,500 per family.

For this paragraph to be correct, the ACA must be the reason the CMS actuaries have lowered their 2016 health spending projections. That is flatly untrue.

You should read Blahous’s whole piece, but here are a few important points to highlight. First, there is no denying that the growth in health-care costs has slowed. However, a look at the national health-spending data shows that the slowdown in cost inflation began in 2003, and has paused since 2009. The president’s law, passed in 2010, can’t be responsible for that reduction. But when cost growth stayed low since 2009, the Centers for Medicare & Medicaid Services (CMS) did revise its estimates, after the passage of the ACA, there’s no denying that. But as Blahous explains, the CMS actuaries have actually explained the reasons for those revisions, and their report breaks them down into five categories.....

. . . “The system will not work perfectly on Dec. 1, but it will operate much better than it did in October,” Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services, the federal agency in charge of HealthCare.gov, told reporters on Monday.

Even if it does work better for consumers, there are still problems — particularly the scrambled reports insurers are getting about people who have signed up for coverage through HealthCare.gov. Insurers say they are getting duplicate records and reports that misstate family relationships, such as listing a child as a spouse.

In some cases, enrollment reports are disappearing. With these “orphan records,” insurers have no way of knowing whether a person is signed up for coverage, unless a new customer happens to call the company with questions.

“The biggest concern is that there are going to be people showing up to get their care,” said one person close to the insurance industry, who spoke on the condition of anonymity to discuss sensitive issues. “Then [the doctors or hospitals] call us and we have no record, and then the consumer is left frustrated and worried and scared.”

Until such errors stop, “you can’t open the floodgates” to large numbers of Americans using the Web site to sign up for coverage, said an insurance industry official who also spoke on the condition of anonymity to discuss private conversations with administration officials about how to improve the system.

The ripple effects of these flaws affect consumers, because the new coverage does not begin until they pay their first monthly insurance premiums. And without accurate information about new customers, health plans cannot send them correct bills.

Almost 80 million people with employer health plans could find their coverage canceled because they are not compliant with ObamaCare, several experts predicted.

Their losses would be in addition to the millions who found their individual coverage cancelled for the same reason.

Stan Veuger of the American Enterprise Institute said that in addition to the individual cancellations, “at least half the people on employer plans would by 2014 start losing plans as well.” There are approximately 157 million employer health care policy holders.

Avik Roy of the Manhattan Institute added, “the administration estimated that approximately 78 million Americans with employer sponsored insurance would lose their existing coverage due to the Affordable Care Act.” [...]

According to projections the administration itself issued back in July 2010, it was clear officials knew the impact of ObamaCare three years ago.

In fact, according to the Federal Register, its mid-range estimate was that by the end of 2014, 76 percent of small group plans would be cancelled, along with 55 percent of large employer plans.

The "Cadillac tax" is a 40% excise tax on more generous employer-provided plans (i.e., the kind that used to be traditional in good companies.) The 40% tax is on the employer and discourages more generous health insurance plans with a tax disincentive. So the employer gets taxed for giving employees good insurance. How's that for "if you like your plan, you can keep your plan"?
[/I]

For 75 million Americans who get their insurance through large companies, the Affordable Care Act is a mixed bag. Experts tell NBC News the new healthcare law is only slightly increasing premiums next year, but causing some companies with the most generous plans to reduce their employees’ benefits.

Aaron Baker, 36, his wife Billie and their two young children are covered under a generous health insurance plan offered by the private Midwestern university where he’s worked for 10 years. When they opened their benefits notice this year, they were pleased to see their $385 premium is only up by four dollars next year. However, they were shocked to discover that instead of covering the first dollar they spend with no deductible, the Baker’s plan now includes a $1,000 deductible and a $2,500 out of pocket maximum. They also will still have small co-pays for services.

According to the enrollment notice, the changes are “to relieve future health plan trend pressure and to put the university in a position to avoid the excise tax that becomes effective in 2018.” The 40 percent excise tax—often called the “Cadillac tax”— is part of Obamacare and is levied on the most generous health plans. It’s designed to bring down overall health costs by making companies and workers more cost-conscious. The thinking is that if consumers have to pay more expenses themselves, through higher deductibles and out-of-pocket expenses, they’ll avoid unnecessary or overly costly procedures. And that is supposed to make care more affordable for everyone.

Billie Baker doesn’t think much of that concept. “I think that saying that your insurance is too good so we're going to give you a penalty,” she said, “is sort of outrageous to me.”

Said Aaron, “You would think the government would want employers to offer good health care packages to their employees. It seems like that is not the case.”

A survey by the International Foundation of Employees Benefits Plans (IFEBP) released in August found that 16.8 percent of respondents had already started to redesign their health plans to avoid the “Cadillac” tax and 40 percent said they are considering action. A survey of Fortune 1000 companies by Towers Watson, a top benefits consulting firm, found a much higher number. Sixty percent of the these major companies, which employ about 20 million American workers, say the looming excise tax is already having a “moderate” or “significant” influence on benefits decisions for 2014 and 2015. Though the tax doesn’t take effect for years, some companies are starting to make gradual changes now so as not to make dramatic changes at the last minute.
The tax will require a company to pay a 40 percent levy, starting in 2018, on the amount by which the total costs of health plans exceeds an annual limit of $10,200 for an individual and $27,500 for a family.

“There are many factors that result in health care costs going up at certain levels,” said Ron Fontanetta, a director at Towers Watson, “but there's no question that we've seen some action on the part of employers in part because of the concern of a looming excise tax.”

“We've had employers shifting costs to employees for some time. But this is really very different,” said Robert Laszewski, president of Health Policy and Strategy Associates, a consultant who works for health industry firms.

“This is more of a seismic change, because most employers are looking forward to this Cadillac tax in 2018 and realizing they're going to have to get ready for it now. And you can't just shift costs to avoid it; you have to cut benefits.”

The Cleveland Clinic, which is ranked among the top four U.S. hospitals, is making layoffs and cutting its budget more than $100 million as a direct result of the Affordable Care Act, the Daily Caller has learned.

“The cuts for 2014, about half of those are related to the Affordable Care Act…We anticipate a reduction in workforce,” Cleveland Clinic executive director of communications Eileen Sheil said in an interview with TheDC.

The Cleveland Clinic is reducing its 2014 budget by $330 million.

“We offered early retirement to 3,000 employees,” Sheil said, but noted that the early retirement option recently offered to staff was “voluntary” for eligible employees.

“The $330 million cut is not all layoffs,” Sheil said, noting that the Clinic is also cutting operating-room expenses and paying less to vendors.

“We’re taking money out of vendors, renegotiating contracts, looking at where we can reduce duplications, improve supply chain efficiencies…how we can scale back and use less. How we can take costs out of our operating rooms,” Sheil said.

“We were able to take 23 percent out of common operations procedure by doing things more efficiently,” Shiel said...

Bill Elliot was a cancer patient who lost his insurance due to ObamaCare and couldn’t pay the expensive new premiums. He was talking about paying the ObamaCare fine, going without health insurance and “letting nature take its course.”

He went on FOX News where his story was picked up by C. Steven Tucker, a health insurance broker who helped him keep his insurance.

Now suddenly Bill Elliot is being audited for 2009 with an interview only scheduled in April 2014. Assuming he lives that long. That might be a coincidence, but Tucker is being audited back to 2003.